1/2-Brief CBT for Pediatric Anxiety and Depression in Primary Care

初级保健中小儿焦虑和抑郁的 1/2 简短 CBT

基本信息

批准号：
8616811
负责人：
V Robin Weersing
金额：
$ 24.37万
依托单位：
SAN DIEGO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-05-03 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8616811
关键词：
Abdominal Pain Adolescent Adopted African American Age Anxiety Anxiety Disorders Area Award Behavioral Budgets Caring Caucasians Caucasoid Race Child Childhood Clinic Clinical Clinical Sciences Clinical Treatment Clinical Trials Cognitive Therapy Collaborations Communities Community Health Community Practice Comorbidity Complement Consult Consultations Data Data Collection Depression and Suicide Development Disease Doctor of Philosophy Early Intervention Early identification Early treatment Economics Effectiveness of Interventions Enrollment Ethnic Origin Evaluation Faculty Family Feasibility Studies Focus Groups Foundations Future Health Maintenance Organizations Health Services Health Services Accessibility Health Services Research Healthcare Hispanics Human Resources Individual Institutes Institution Intervention Investigation Ions Lead Leadership Low income Manuals Measures Mental Depression Mental Health Mental Health Services Mentorship Minority Mission Modeling Monitor Mood Disorders Neighborhoods Outcome Paper Parents Participant Patient Self-Report Patients Pediatric Hospitals Pediatrics Persons Pilot Projects Poly(ADP-ribose) Polymerases Population Positioning Attribute Postdoctoral Fellow Poverty Practice based research Prevention Primary Health Care Principal Investigator Procedures Protocols documentation Public Health Randomized Recording of previous events Recruitment Activity Research Research Infrastructure Research Personnel Research Project Grants Resistance Resources Risk Robin bird Safety Sampling Schedule Services Severities Site Symptoms Testing TimeLine Training Translational Research Travel Uninsured Universities Ursidae Family Work Youth base blind brief intervention child depression cost effectiveness data management depression prevention depressive symptoms design early onset effective therapy effectiveness research ethnic minority population gastrointestinal health care delivery health care referral health organization innovation medical specialties member novel strategies operation pediatrician pi-Mesons practice-based research network primary care setting programs psychologic randomized trial response symposium therapy development treatment program treatment response

项目摘要

This application describes an interlocking, two-site collaborative R01 to test the effects of a brief cognitive behavioral therapy (BCBT) protocol for youths (age 8-15) presenting with anxiety and/or depression in primary care. Over a five year period, 210 youths (105 per site) will be randomly assigned to (a) BCBT delivered in primary care or (b) enhanced referral to specialty mental health care (SMHC). This application builds on a preliminary study (N=60), in which a pilot version of BCBT was well-accepted by families and clinicians and was more efficacious than referral to SMHC. We now propose to test BCBT against an enhanced SMHC referral model in a larger, more diverse sample to establish its utility as a community-based intervention. Outcomes will be assessed by independent evaluators blind to participant status at 16 and 32 weeks post- randomization (Aim 1). It is hypothesized that BCBT will be superior to enhanced SMHC referral in terms of overall clinical improvement (CGI-I </= 2) and change in anxiety (PARS) and depression (CDRS-R) symptoms. Response also will be evaluated on brief self-report measures (SCARED, MFQ), as future community care may need to rely more heavily on these types of assessments. In addition, individual trajectories of participants will be examined to understand predictors of treatment response (Aim 2). It is hypothesized that severity of depression symptoms (youth and/or parent) will predict poorer response across treatments but that the BCBT program will still outperform the enhanced SHMC referral model. The effects of ethnicity also will be explored and use of two sites will allow greater enrollment of Hispanic (San Diego) and African-American (Pittsburgh) families than could be achieved by either in isolation. Targeting depression and anxiety as a unified problem area is innovative and in line with calls for new approaches to conceptualizing comorbidity and treating near neighbor disorders. Availability of an effective BCBT program for internalizing youths is needed as service settings struggle with limited sessions and resources available to train clinicians in multiple protocols. The application is noteworthy in adopting a deployment-focused model and testing this intervention early in its development within a real world context (primary care) and against a plausible public health comparision condition (enhanced SMHC referral) relevant for future treatment dissemination. Primary care has become a de facto site of mental health care delivery, with the possibilities of easier access, earlier identification and treatment, and prevention of chronicity. In line with this focus, data will be collected on the cost-effectiveness of the program (Aim 3) in order to lay the groundwork for future investigations focused on issues of dissemination, implementation, and real world sustainability. Site-unique contributions include expertise in practice-based research (San Diego) and data coordination (Pittsburgh). San Diego will serve as the overall coordinating site for the project.

该应用程序描述了一种互锁的两个站点协作R01，以测试简短的认知行为疗法（BCBT）方案对初级保健中焦虑和/或抑郁症的年轻人（8-15岁）的效果。在五年内，将将210名年轻人（每个站点105）随机分配给（a）在初级保健中提供的BCBT或（b）增强转诊至专业精神保健（SMHC）。该申请基于初步研究（n = 60），在该研究中，BCBT的试点版本受到家庭和临床医生的良好感知，并且比转介SMHC更有效。现在，我们建议在更大，更多样化的样本中对增强的SMHC推荐模型进行测试，以确立其作为基于社区的干预措施的实用性。结果将在随机分组后16周和32周对参与者身份的独立评估者评估（AIM 1）。假设BCBT在总体临床改善（CGI-I </= 2）和焦虑（PARS）和抑郁症（CDRS-R）症状方面将优于SMHC推荐的增强。还将根据简短的自我报告措施（Scared，MFQ）进行评估，因为未来的社区护理可能需要更严重地依靠这些类型的评估。此外，将检查参与者的个体轨迹，以了解治疗反应的预测指标（AIM 2）。假设抑郁症状的严重程度（青年和/或父母）将预测整个治疗方法的反应较差，但BCBT计划仍然表现优于增强的SHMC推荐模型。还将探索种族的影响，使用两个地点将使西班牙裔（圣地亚哥）和非裔美国人（匹兹堡）家庭的入学率更高，而不是孤立的。将抑郁和焦虑作为统一问题领域具有创新性，并且与呼吁新方法概念化合并症和邻近疾病的治疗方法一致。由于服务环境与有限的会议和资源为培训多个协议培训临床医生的有限的会议和资源，因此需要有效的BCBT计划来内部化年轻人。值得注意的是，该应用在采用以部署为中心的模型并在现实世界中（初级保健）的早期开发和与可靠的公共卫生比较条件（增强的SMHC转介）相关的合理的公共卫生比较条件（增强的SMHC转诊）进行测试。初级保健已成为心理保健提供的事实上，具有更容易获得，早期识别和治疗以及预防慢性的可能性。与此重点相一致，将收集有关该计划的成本效益（AIM 3）的数据，以便为未来的调查奠定基础，该调查集中在传播，实施和现实世界的可持续性问题上。站点唯一的贡献包括基于实践的研究（圣地亚哥）和数据协调（匹兹堡）的专业知识。圣地亚哥将作为该项目的整体协调站点。